Low Vision and Depression

By Bruce R. Rosenthal, OD, FAAO

Mrs. R.M., an 86-year-old woman with macular degeneration,
is brought to a low vision examination by her daughter. She is
withdrawn, and has difficulty describing her recent eye care history.
Her daughter reports that her mother has stopped going out with
friends, and often seems fatigued. During the examination, Mrs. M.
finds it hard to concentrate on the low vision devices being shown to
her, and is unresponsive to any strategies suggested.

Depression and Vision Loss

Loss of visual function may be caused by eye conditions that affect
the ability to read, see faces, or travel independently. This loss can
be devastating because of its consequences. Some individuals may be in
jeopardy of losing a job, while others may be forced to give up
driving, which symbolizes independence and freedom of movement. Still
others may be faced with the prospect of being unable to cope
independently, and may have to move into a nursing home. It is not
unusual for providers of low vision care to witness depression among
their patients. According to the Mayo Clinic, many factors have been
linked with depression, including: life changes, illness, medications,
biochemical factors, history of mental or emotional disorders, and
substance abuse. A heart attack, Parkinson's disease, stroke, or vision
loss may lead to life changes that can cause depression. Individuals
may exhibit the same emotional reactions to the loss of vision as those
who lose a loved one or a limb. These reactions include: shock,
depression, anxiety, disbelief, grief, denial or anger.

The person may also be affected by the recency of onset, severity,
and suddenness of the loss of vision. They may experience a stage of
shock where they refuse to think about the present situation, or they
may appear unresponsive. This stage is often followed by depression. As
the Mehrs state, an individual may then have feelings of hopelessness,
lack of self-confidence, suicidal thoughts, self-recrimination, and
psycho-motor retardation. As the person with low vision goes from
doctor to doctor for the "magic" cure that will restore lost vision,
only to be told that nothing further can be done, depression may
intensity. "Many doctors, while dealing competently with diagnosis and
treatment in the acute phase, are not aware of the patient's reaction
to diminished sight", says Dr. Eleanor Faye, Clinical Advisor, Center
Education, Lighthouse International.

Common Symptoms

Patients with vision loss may exhibit a response in any of the four
basic psychological domains: emotional, cognitive, perceptual, and
behavioral. Clinicians dealing with patients who have impaired vision
should look for symptoms of depression that warrant treatment,
including:

A persistent, pervasive depressed mood

Loss of interest or pleasure in usual activities

Increase or decrease in appetite or weight

Insomnia or hypersomnia

Psychomotor agitation or retardation

Fatigue or loss of energy

Feelings of worthlessness or excessive/inappropriate guilt

Impaired thinking or concentration

Recurrent thoughts of death: suicidal ideas, plans, and attempts

Clinicians working with patients exhibiting these symptoms should
help to arrange an appointment with a psychiatrist or psychologist who
understands the problems of vision impairment. Having a social worker
on the multidisciplinary low vision team can enhance the capability to
assess, counsel, or refer the person with depression and vision loss.

Vision Rehabilitation Can Help

Low vision care and other vision rehabilitation interventions can be important steps in the rehabilitation process. Mehr noted that
depression could be overcome if tasks could be accomplished that the
individual had seen as too difficult to do. Ellerbrock even suggested
that mastering tasks, such as navigating to the bathroom alone or
reading a letter with an optical device would help to overcome
depression. Low vision devices, therefore, become an integral part of
the process of regaining self-esteem, overcoming feelings of
hopelessness, and regaining emotional strength as compensatory
strategies are learned. An additional benefit of the low vision
evaluation process, according to Dr. Faye, is the opportunity it
affords "the understandably depressed person ... to ask questions about
treatment, about the eye disease, and to express the frustration
inherent in the experience of losing sight. Usually the realization
that they can air their problems and that it's okay to talk about them
gets the therapeutic ball rolling."